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                              DOMNULE PRESEDINTE,
   Subsemnatul ………….., domiciliat in localitatea …………….., judetul ……………, str. ……………, nr. …….., etajul ………, apart. …….., va rog ca – in conformitate cu art. 376 C. proc. civ. – sa investiti cu formula executorie alaturatul act autentificat de Biroul notarial ……………, pe care il depun in original si prin care ……………….. ……………………….(numele, prenumele si adresa datornicului si continutul, cauza si termenul obligatiei sale). Asa cum rezulta din acest act, obligatia datornicului este certa, lichida si exigibila, iar subsemnatul am calitatea, dreptul si interesul de a cere executarea ei.
 Semnatura petitionarului,
 …………………….
   DOMNULUI PRESEDINTE AL ……………….

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